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Is there disproportionate impairment in semantic or phonemic fluency in schizophrenia?

Published online by Cambridge University Press:  13 January 2003

Kremen William S. ,
Seidman Larry J. ,
Faraone Stephen V.  and
Tsuang Ming T.
Kremen William S.*
Affiliation:
Department of Psychiatry, University of California, Davis School of Medicine, 2230 Stockton Blvd., Sacramento, CA, and UC Davis–Napa Psychiatric Research Center, Napa State Hospital, Napa, CA
Seidman Larry J.
Affiliation:
Harvard Medical School Department of Psychiatry at Massachusetts Mental Health Center, Brockton-West Roxbury VA Medical Center and Massachusetts General Hospital, and Harvard Institute of Psychiatric Epidemiology and Genetics, 74 Fenwood Road, Boston, MA
Faraone Stephen V.
Affiliation:
Harvard Medical School Department of Psychiatry at Massachusetts Mental Health Center, Brockton-West Roxbury VA Medical Center and Massachusetts General Hospital, and Harvard Institute of Psychiatric Epidemiology and Genetics, 74 Fenwood Road, Boston, MA
Tsuang Ming T.
Affiliation:
Harvard Medical School Department of Psychiatry at Massachusetts Mental Health Center, Brockton-West Roxbury VA Medical Center and Massachusetts General Hospital, and Harvard Institute of Psychiatric Epidemiology and Genetics, 74 Fenwood Road, Boston, MA
*
Reprint requests to: William S. Kremen, Ph.D., Department of Psychiatry, University of California, Davis School of Medicine, 2230 Stockton Boulevard, Sacramento, CA 95817. E-mail: wskremen@ucdavis.edu
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Abstract

Phonemic and semantic fluency involve the capacity to generate words beginning with particular letters or belonging to particular categories, respectively. The former has been associated with frontal lobe function and the latter with temporoparietal function, but neuroimaging studies indicate overlap of underlying neural networks. Schizophrenia patients may experience disproportionate semantic fluency impairment owing to abnormal semantic organization; however, executive dysfunction in schizophrenia suggests possible disproportionate phonemic fluency impairment. Moreover, little is known about the diagnostic specificity of either verbal fluency deficit to schizophrenia or their stability over time. We examined 83 schizophrenia patients, 15 bipolar disorder patients, and 83 normal controls. Both fluency types were impaired in schizophrenia patients. Schizophrenia patients as a whole manifested disproportionate semantic fluency impairment relative to bipolar disorder patients, but only a subset of schizophrenia patients manifested disproportionate semantic fluency impairment relative to controls. Few characteristics, except to some extent paranoid-nonparanoid subtype, meaningfully differentiated schizophrenia patients with and without this disproportionate impairment. Verbal fluency measures were moderately stable over a 4-year period in schizophrenia patients and controls (.48 < rs < .79). These results mirror a literature that overall suggests a small degree of disproportionate semantic fluency impairment in schizophrenia, but also some heterogeneity in fluency deficits. (JINS, 2003, 9, 79–88.)

Keywords

Verbal fluencySemantic memoryFrontal cortexTemporoparietal cortexSchizophrenia
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 9 , Issue 1 , January 2003 , pp. 79 - 88
Copyright
Copyright © The International Neuropsychological Society 2003

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References

American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd rev. ed.). Washington, DC: American Psychiatric Press.Google Scholar
Andreasen, N.C. (1983). Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa.Google Scholar
Andreasen, N.C. (1984). Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa.Google Scholar
Andreasen, N.C., Paradiso, S., & O'Leary, D.S. (1998). “Cognitive dysmetria” as an integrative theory of schizophrenia: A dysfunction in cortical-subcortical-cerebellar circuitry? Schizophrenia Bulletin, 24, 203–218.Google Scholar
Arango, C., Bartko, J.J., Gold, J.M., & Buchanan, R.W. (1999). Prediction of neuropsychological performance by neurological signs in schizophrenia. American Journal of Psychiatry, 156, 1349–1357.Google Scholar
Baldo, J.V. & Shimamura, A.P. (1998). Letter and category fluency in patients with frontal lobe lesions. Neuropsychology, 12, 259–267.CrossRefGoogle Scholar
Beatty, W.W., Jocic, Z., Monson, N., & Staton, D. (1993). Memory and frontal lobe dysfunction in schizophrenia and schizoaffective disorder. Journal of Nervous and Mental Disease, 181, 448–453.CrossRefGoogle Scholar
Benton, A.L. (1967). Problems of test construction in the field of aphasia. Cortex, 3, 32–58.CrossRefGoogle Scholar
Benton, A.L. (1968). Differential behavioral effects in frontal lobe disease. Neuropsychologia, 6, 53–60.CrossRefGoogle Scholar
Brébion, G., Amador, X., Smith, M.J., & Gorman, J.M. (1998). Memory impairment in schizophrenia: The role of processing speed. Schizophrenia Research, 30, 31–39.CrossRefGoogle Scholar
Butters, N., Granholm, E., Salmon, D., Grant, I., & Wolfe, J. (1987). Episodic and semantic memory: A comparison of amnesic and demented patients. Journal of Clinical and Experimental Neuropsychology, 9, 479–497.CrossRefGoogle Scholar
Chapman, L.J. & Chapman, J.P. (1978). The measurement of differential deficit. Journal of Psychiatric Research, 14, 303–311.CrossRefGoogle Scholar
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum.Google Scholar
Dalby, J.T. & Williams, R. (1986). Preserved reading and spelling ability in psychotic disorders. Psychological Medicine, 16, 171–175.CrossRefGoogle Scholar
DeLisi, L.E., Boccio, A.M., Riordan, H., Hoff, A.L., Dorfman, A., McClelland, J., Kushner, M., Van Eyl, O., & Oden, N. (1991). Familial thyroid disease and delayed language development in first admission patients with schizophrenia. Psychiatry Research, 38, 39–50.CrossRefGoogle Scholar
Elvevåg, B., Weinstock, D.M., Akil, M., Kleinman, J.E., & Goldberg, T.E. (2001). A comparison of verbal fluency tasks in schizophrenic patients and normal controls. Schizophrenia Research, 51, 119–126.CrossRefGoogle Scholar
Endicott, J. & Spitzer, R.L. (1978). A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry, 35, 837–844.CrossRefGoogle Scholar
Faraone, S.V., Seidman, L.J., Kremen, W.S., Pepple, J.R., Lyons, M.J., & Tsuang, M.T. (1995). Neuropsychological functioning among the nonpsychotic relatives of schizophrenic patients: A diagnostic efficiency analysis. Journal of Abnormal Psychology, 104, 286–304.CrossRefGoogle Scholar
Feinstein, A., Goldberg, T.E., Nowlin, B., & Weinberger, D.R. (1998). Types and characteristics of remote memory impairment in schizophrenia. Schizophrenia Research, 30, 155–163.CrossRefGoogle Scholar
Freund, R.J., Littell, R.C., & Spector, P.C. (1986). SAS system for linear models. Carey, NC: SAS Institute.Google Scholar
Friston, K.J., Frith, C.D., Fletcher, P., Liddle, P.F., & Frackowiak, R.S. (1996). Functional topography: Multidimensional scaling and functional connectivity in the brain. Cerebral Cortex, 6, 156–164.CrossRefGoogle Scholar
Frith, C.D., Firston, K.J., Herold, S., Silbersweig, D., Fletcher, P., Cahill, C., Dolan, R.J., Frackowiak, R.S., & Liddle, P.F. (1995). Regional brain activity in chronic schizophrenic patients during the performance of a verbal fluency task. British Journal of Psychiatry, 167, 343–349.CrossRefGoogle Scholar
Goldberg, T.E., Aloia, M.S., Gourovitch, M.L., Missar, D., Pickar, D., & Weinberger, D.R. (1998). Cognitive substrates of thought disorder, I: The semantic system. American Journal of Psychiatry, 155, 1671–1676.CrossRefGoogle Scholar
Gourovitch, M.L., Goldberg, T.E., & Weinberger, D.R. (1996). Verbal fluency deficits in patients with schizophrenia: Semantic fluency is differentially impaired as compared with phonologic fluency. Neuropsychology, 10, 573–577.CrossRefGoogle Scholar
Gourovitch, M.L., Kirkby, B.S., Goldberg, T.E., Daniel, R., Gold, J.M., Esposito, G., Van Horn, J.D., & Berman, K.F. (2000). A comparison of rCBF patterns during letter and semantic fluency. Neuropsychology, 14, 353–360.CrossRefGoogle Scholar
Gruzelier, J., Seymour, K., Wilson, L., Jolley, A., & Hirsch, S. (1988). Impairments on neuropsychological tests of temporohippocampal and frontohippocampal function and word fluency in remitting schizophrenia and affective disorders. Archives of General Psychiatry, 45, 623–629.CrossRefGoogle Scholar
Heckers, S. (1997). Neuropathology of schizophrenia: Cortex, thalamus, basal ganglia, and neurotransmitter-specific projection systems. Schizophrenia Bulletin, 23, 403–421.CrossRefGoogle Scholar
Heinrichs, R.W. & Zakzanis, K.K. (1998). Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology, 12, 426–445.CrossRefGoogle Scholar
Jastak, S. & Wilkinson, G. (1984). The Wide Range Achievement Test–Revised. Wilmington, DE: Jastak Associates.Google Scholar
Joyce, E.M., Collinson, C., & Crichton, P. (1996). Verbal fluency in schizophrenia: Relationship with executive function, semantic memory and clinical alogia. Psychological Medicine, 26, 39–49.CrossRefGoogle Scholar
Kremen, W.S., Seidman, L.J., Faraone, S.V., Pepple, J.R., Lyons, M.J., & Tsuang, M.T. (1995). The “3 Rs” and neuropsychological function in schizophrenia: Application of the matching fallacy to biological relatives. Psychiatry Research, 56, 135–143.CrossRefGoogle Scholar
Kremen, W.S., Seidman, L.J., Faraone, S.V., Pepple, J.R., Lyons, M.J., & Tsuang, M.T. (1996). The “3 Rs” and neuropsychological function in schizophrenia: An empirical test of the matching fallacy. Neuropsychology, 10, 22–31.CrossRefGoogle Scholar
Kremen, W.S., Seidman, L.J., Faraone, S.V., & Tsuang, M.T. (2001). Intelligence quotient and neuropsychological profiles in patients with schizophrenia and normal volunteers. Biological Psychiatry, 50, 453–462.CrossRefGoogle Scholar
Laurent, A., Biloa-Tang, M., Bougerol, T., Duly, D., Anchisi, A.-M., Bosson, J.-L., Pellat, J., d'Amato, T., & Dalery, J. (2000). Executive/attentional performance and measures of schizotypy in patients with schizophrenia and in their nonpsychotic first-degree relatives. Schizophrenia Research, 46, 269–283.CrossRefGoogle Scholar
Lawrie, S.M. & Abukmeil, S.S. (1998). Brain abnormality in schizophrenia A systematic and quantitative review of volumetric magnetic resonance imaging studies. British Journal of Psychiatry, 172, 110–120.CrossRefGoogle Scholar
Lezak, M. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford.Google Scholar
Maddock, R.J. (1999). Retrosplenial cortex and emotion: New insights from functional imaging studies of the human brain. Trends in Neuroscience, 22, 310–316.CrossRefGoogle Scholar
Maher, B.A., Manschreck, T.C., & Molino, M.A.C. (1983). Redundancy, pause distribution, and thought disorder in schizophrenia. Language and Speech, 26, 191–199.CrossRefGoogle Scholar
Martin, A. & Fedio, P. (1983). Word production and comprehension in Alzheimer's disease: The breakdown in semantic knowledge. Brain and Language, 19, 124–141.CrossRefGoogle Scholar
Martin, A., Wiggs, C.L., Lalonde, F., & Mack, C. (1994). Word retrieval to letter and semantic cues: A double dissociation in normal subjects using interference tasks. Neuropsychologia, 32, 1487–1494.CrossRefGoogle Scholar
McCarley, R.W., Wible, C.G., Frumin, M., Hirayasy, Y., Levitt, J.J., Fischer, I.A., & Shenton, M.E. (1999). MRI anatomy of schizophrenia. Biological Psychiatry, 45, 1099–1119.CrossRefGoogle Scholar
Milner, B. (1964). Some effects of frontal lobotomy in man. In J.M. Warren & K. Akert (Eds.), The frontal granular cortex and behavior (pp. 313–331). New York: McGraw-Hill.Google Scholar
Monsch, A.U., Bondi, M.W., Butters, N., Paulsen, J.S., Salmon, D.P., Brugger, P., & Swenson, M.R. (1994). A comparison of category and letter fluency in Alzheimer's disease and Huntington's disease. Neuropsychology, 8, 25–30.CrossRefGoogle Scholar
Moscovitch, M. (1992). A neuropsychological model of memory and consciousness. In L.R. Squire & N. Butters (Eds.), Neuropsychology of memory (pp. 5–22). New York: Guilford.Google Scholar
Moscovitch, M. (1994). Cognitive resources and dual-task interference effects at retrieval in normal people: The role of the frontal lobes and medial temporal cortex. Neuropsychology, 8, 524–534.CrossRefGoogle Scholar
Mummery, C.J., Patterson, K., Hodges, J.R., & Wise, R.J. (1996). Generating ‘tiger’ as an animal name or a word beginning with T: Difference in brain activation. Proceedings of the Royal Society of London. Series B: Biological Sciences, 263, 989–995.Google Scholar
Newcombe, F. (1969). Missile wounds of the brain. London: Oxford University Press.Google Scholar
Paulesu, E., Goldacre, B., Scifo, P., Cappa, S.F., Gilardi, M.C., Castiglioni, I., Perani, D., & Fazio, F. (1997). Functional heterogeneity of left inferior frontal cortex as revealed by fMRI. NeuroReport, 8, 2011–2016.CrossRefGoogle Scholar
Paulsen, J.S., Romero, R., Chan, A., Davis, A.V., Heaton, R.K., & Jeste, D.V. (1996). Impairment of the semantic network in schizophrenia. Psychiatry Research, 63, 109–121.CrossRefGoogle Scholar
Pujol, J., Vendrell, P., Deus, J., Kulisevsky, J., Marti-Vilalta, J.L., Garcia, C., Junque, C., & Capdevila, A. (1996). Frontal lobe activation during word generation studied by functional MRI. Acta Neurologica Scandinavica, 93, 403–410.CrossRefGoogle Scholar
Rosen, W.G. (1980). Verbal fluency in aging and dementia. Journal of Clinical Neuropsychology, 2, 135–146.CrossRefGoogle Scholar
Roxborough, H., Muir, W.J., Blackwood, D.H.R., Walker, M.T., & Blackburn, I.M. (1993). Neuropsychological and P300 abnormalities in schizophrenics and their relatives. Psychological Medicine, 23, 305–314.CrossRefGoogle Scholar
Seidman, L.J. (1983). Schizophrenia and brain dysfunction: An integration of recent neurodiagnostic findings. Psychological Bulletin, 94, 195–238.CrossRefGoogle Scholar
Seidman, L.J., Cassens, G., Kremen, W.S., & Pepple, J.R. (1992). The neuropsychology of schizophrenia. In R.F. White (Ed.), Clinical syndromes in adult neuropsychology: The practitioner's handbook (pp. 381–449). Amsterdam: Elsevier.Google Scholar
Seidman, L.J., Kremen, W.S., Koren, D., Faraone, S.V., Toomey, R., & Tsuang, M.T. (2002). A comparative profile analysis of neuropsychological function in schizophrenia and bipolar psychoses. Schizophrenia Research, 53, 31–44.CrossRefGoogle Scholar
Spence, S.A., Liddle, P.F., Stefan, M.D., Hellewell, J.S., Sharma, T., Friston, K.J., Hirsch, S.R., Frith, C.D., Murray, R.M., Deakin, J.F., & Grasby, P.M. (2000). Functional anatomy of verbal fluency in people with schizophrenia and those at genetic risk: Focal dysfunction and distributed disconnectivity reappraised. British Journal of Psychiatry, 176, 52–60.CrossRefGoogle Scholar
Spitzer, M., Braun, U., Hermle, L., & Maier, S. (1993). Associative semantic network dysfunction in thought-disordered schizophrenic patients: Direct evidence from indirect semantic priming. Biological Psychiatry, 34, 864–877.CrossRefGoogle Scholar
Toomey, R., Kremen, W.S., Simpson, J.C., Samson, J.A., Seidman, L.J., Lyons, M.J., Faraone, S.V., & Tsuang, M.T. (1997). Revisiting the factor structure for positive and negative symptoms: Evidence from a large heterogeneous group of psychiatric patients. American Journal of Psychiatry, 154, 371–377.CrossRefGoogle Scholar
Troyer, A.K., Moscovitch, M., Winocur, G., Alexander, M.P., & Stuss, D. (1998). Clustering and switching on verbal fluency: The effects of focal frontal- and temporal-lobe lesions. Neuropsychologia, 36, 499–504.CrossRefGoogle Scholar
Vincent, K.R., Castillo, I.M., Hauser, R.I., Zapata, J.A., Stuart, H.J., Cohn, C.K., & O'Shanick, G.J. (1984). MMPI-168 codebook. Norwood, NJ: Ablex.Google Scholar
Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence Scale–Revised. San Antonio, TX: Psychological Corporation.Google Scholar
Weinberger, D.R., Aloia, M.S., Goldberg, T.E., & Berman, K.F. (1994). The frontal lobes and schizophrenia. The Journal of Neuropsychiatry and Clinical Neurosciences, 6, 419–427.Google Scholar